During the course of a week at an overnight summer camp, 4 children age 7-9 are sent to the camp health center. They each have fever, cough, congestion, sore throat, and red eyes. Physical examination of the children shows bilateral conjunctival injection and an erythematous oropharynx. Auscultation of one child also reveals crackles in the left lower lung field. All the children's symptoms improve over 7 days with supportive care. Which of the following is the most likely cause of the outbreak?

Question

During the course of a week at an overnight summer camp, 4 children age 7-9 are sent to the camp health center.  They each have fever, cough, congestion, sore throat, and red eyes.  Physical examination of the children shows bilateral conjunctival injection and an erythematous oropharynx.  Auscultation of one child also reveals crackles in the left lower lung field.  All the children's symptoms improve over 7 days with supportive care.  Which of the following is the most likely cause of the outbreak?

Quizplus · Accepted Answer

11ec160b_3863_f997_9249_f31df179a59e_MD0001_00 Adenovirus infection is a common, usually self-limiting, disease caused by a double-stranded DNA genome that is transmitted via direct contact, fecal-oral route, or respiratory droplets. Adenovirus infection occurs year-round and in outbreaks in crowded quarters (eg, day care centers, camp dormitories, military barracks). Viral replication in epithelial cells can give rise to varying manifestations of disease based on serotype, with upper respiratory involvement as the most common. Pharyngoconjunctival fever is characterized by the acute onset of fever, cough, congestion, pharyngitis, and conjunctivitis. Physical examination usually reveals an erythematous oropharynx with bilateral, follicular conjunctival injection and serous discharge. Pneumonia occurs in a small percentage of patients, such as the child with focal crackles. (Choice B) In young children, hand-foot-and-mouth disease is caused by coxsackievirus. Painful vesicles develop in the oropharynx and on the hands (eg, palms, dorsal fingers) and feet (eg, soles, sides). Coxsackievirus can also cause herpangina, an illness characterized by fever with posterior pharyngeal vesicles and without a rash. (Choice C) Influenza viruses cause acute onset of high fever, cough, muscle aches, and malaise with a peak incidence during the winter. In children, infection can be complicated by febrile seizures, vomiting, acute otitis media, and pneumonia. (Choice D) Norovirus causes rapid-onset, self-limiting gastroenteritis in outbreak settings (eg, restaurants, child care facilities, cruise ships). In addition to vomiting and diarrhea, fever, headache, and malaise are common. (Choice E) Parvovirus B19 causes erythema infectiosum (fifth disease) in school-aged children and presents with fever, malaise, and a classic "slapped cheek" rash. (Choice F) Respiratory syncytial virus (RSV) classically causes lower respiratory tract disease (eg, bronchiolitis, pneumonia) in infants. Although older children and adults can develop respiratory infection and outbreaks can occur in close quarters, RSV is a seasonal virus that peaks in the winter months. Educational objective: Adenovirus is a self-limiting, year-round infection that causes the acute onset of fever, cough, congestion, pharyngitis, and conjunctivitis. This pharyngoconjunctival disease can occur in outbreaks among those living in close quarters (eg, camp dormitories, military barracks). __________ References: Adenovirus. (http://www.ncbi.nlm.nih.gov/pubmed/21858752)

During the Course of a Week at an Overnight Summer